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II , <br /> TV <br /> r <br /> NOTE: PULL ALL PERMI S (SEPTIC, WELL, ETC...) 1V1`i E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> jg /ves - <br /> EHD RECEIVED APP.REFERRAL: I COMPLETE & SUBMIT BY_ � �tq z- <br /> DATE DATE <br /> ATTN: L <br /> SITE ADDRESS: JQ0 <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage <br /> SUMMARY OR COMMENTS: <br /> a <br /> 5 <br />} <br /> J <br /> r <br /> I recommend: Approval Denial Continuance Inspector's Signator <br /> Supervisor/Lead Senior Comments: <br /> h <br /> c�. <br /> f <br /> r <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA CHECK OFFLIST " Proafregd repArl? Y Correct LAND,USE#9 ;, <br /> 4 E Lv ed In L WID. SE BOOK? <br /> r, Cnrrec>rCOND( <br /> Eli 06 06 Rev 1199 ? - ':��. 3�t#�t ��=u9F ��d..' :� �41 �� <br />